Thank you.
Good afternoon. Thank you for the opportunity to appear in front of you on this important issue.
I want to begin by acknowledging that the land we are meeting on today is the traditional and unceded territory of the Algonquin nation.
I, like everyone else, have been very concerned about the reports we've all heard of indigenous women being coerced into undergoing sterilization procedures. It is unacceptable that this could happen to any woman anywhere in Canada's health care system. Forced or coerced sterilization is a serious violation of human rights and medical ethics. It's a form of gender-based violence and evidence of a broader need to eliminate racism and discriminatory practices that may exist within our health system.
Unfortunately, there is a documented history of compulsory sterilization in Canada linked to a broader eugenics movement in the 1900s. Institutionalization, regulation of marriage and sterilization were social controls in place in some parts of the country. While these practices were codified in law in some provinces, we know that sterilization without appropriate consent occurred in other parts of the country as well. Women with intellectual disabilities and marginalized, racialized and indigenous women were often the victims. Several well-known academics, including Dr. Karen Stote and Dr. Erika Dyck, have documented this history in detail.
Recent media reports of indigenous women undergoing coerced sterilization procedures suggest that these injustices may have occurred long after laws allowing forced sterilization were repealed. The scope of the issue has not been documented comprehensively, aside from the work of now Senator Boyer and Dr. Judith Bartlett.
It's the responsibility of all players in the health system to ensure that patients have access to health services that are free from bias and discrimination. The Government of Canada takes this obligation seriously. We know that indigenous women, along with other vulnerable women impacted by poverty, mental health, addiction issues and so on, also struggle with bias and safety in the system.
Just as an example, in 2016 Women's College Hospital, following a period of study of over six years, released a report entitled “A Thousand Voices for Women's Health”. It documented how women from diverse communities feel they were treated, and expressed their expectation for services that are responsive to and respectful of individual identities, cultures, and social circumstances, and that are non-judgmental.
We know that in Canada no one level of government has exclusive jurisdiction over health care. It's a complex system of shared jurisdiction, where both the federal government and the provinces and territories have important responsibilities. The federal government, for its part, has important roles to play in ensuring the health and safety of Canadians, making financial contributions to the Canadian health care system through the CHT and setting national standards for health care through the Canada Health Act. Provincial and territorial governments have the primary responsibility, of course, for day-to-day management, organization and delivery of health care services. Each jurisdiction has created its own health care system, but based on common principles.
As part of their responsibilities to administer and deliver health care services, each province and territory has laid out, through statute, its frameworks for oversight of health care professionals by self-regulating bodies. These bodies are responsible for reviewing and responding to complaints against health care professionals under their authority, and for disciplinary action when warranted.
Provinces and territories also have the authority to regulate matters related to a patient's consent for medical treatment. The concept of informed consent has evolved over time. It's complex. The processes for making decisions on treatments that were once almost entirely the domain of providers have shifted over time to greater consideration of the views of patients. Informed consent today is about ensuring that the patient has the information and the capacity to make an informed decision based on the advice and counsel of their health practitioner.
Informed consent means that a patient has received information about the nature of the treatment that's proposed, the expected benefits, risks and side effects, alternative courses of action, and the likely consequences of not receiving treatment. But the consent also has to be valid. For the consent to be valid, the consenting individual must have the capacity to make an informed judgment and to provide their consent voluntarily.
Studies involving women consenting to gynecological procedures show that patients frequently describe feeling compelled to sign a consent form despite their preference not to undertake a procedure. ln a study by Hall, Prochazka and Fink, published in the Canadian Medical Association Journal in 2012, 30% of women consenting to surgery reported that they did not think they had a choice about signing the consent form, and 88% of the respondents perceived the form as strictly administrative. This suggests there are some significant shortcomings in practitioner communication with patients on matters of consent and that how and when consent is obtained from women is important.
All jurisdictions have a role in ensuring that health care services are delivered in a manner that is free from discrimination, no matter where those services are delivered, and no matter who provides the service. The federal government can and does play an important role as catalyst for health care system improvements and for supporting collaboration among multiple players and stakeholders on critical issues.
In just a minute, my colleague from lndigenous Services Canada will elaborate on a number of areas, but I want to speak briefly to our plans specific to improving cultural safety.
Our plan is consistent with the government's overall commitment to advancing reconciliation with indigenous peoples and implementing the Truth and Reconciliation Commission's calls to action. Specifically, calls to action 23 and 24 ask all orders of government to support “cultural competency training for all healthcare professionals” and the calls directed to medical and nursing schools ask them to require that all students have “training in intercultural competency, conflict resolution, human rights, and anti-racism”.
On December 11, 2018, the Minister of Health and the then minister of indigenous services wrote to provincial and territorial ministers and to health professional organizations, among others, seeking their collaboration on and participation in a federal-provincial-territorial working group. Health Canada is taking a leadership role and will partner with provinces, territories and health organizations to take actions that we hope will lead to a significant cultural shift in the Canadian health system; that is, a shift to a system that supports efforts to prevent discriminatory practices and increases access to culturally safe health services for indigenous peoples.
This March, Health Canada will convene provincial and territorial partners to begin discussing areas for collaboration on measures to increase cultural safety in the health care system. This group will work closely with indigenous partners, women and health professional organizations. We expect the federal-provincial-territorial group to build on the good work already under way across the country and to identify opportunities for action in areas such as awareness raising and training.
By way of example, in British Columbia, which is among the most advanced jurisdictions in the country, extensive cultural safety training has already been delivered to providers, administrators and policy-makers throughout the province. Health authorities, institutions, provider organizations and so on in other parts of the country have other initiatives under way as well.
We will collaborate with indigenous partners and governments at the national and regional level and with professional colleges and health organizations. Fortunately, there are opportunities to learn from the experiences of groups who've championed the objective of non-discrimination for some time, such as, for example, the First Nations Health Authority in British Columbia, which has a vision of hard-wiring the concepts of cultural safety and cultural humility into the delivery of health care services.
We know that improving health outcomes, increasing access to culturally appropriate health services and programs and addressing the social determinants of health are high priorities for indigenous leaders and communities across the country.
I believe that the work we are undertaking will increase the level of cultural safety within the health care system, lead to improvements in the quality of service and contribute to reconciliation.
I thank you for the opportunity to make these short remarks. Following my colleague's remarks, I would be pleased to attempt to answer your questions. Thank you.
